Paeds Cases · professional-practice-and-evidence
Adolescent confidentiality OSCE — conditional script, override and the portal breach
Observed structured encounter testing the conditional-confidentiality script, time alone, capacity assessment, a safety override decision and a portal-breach repair.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a routine well-visit with a parent who resists leaving and a young person testing whether the room is safe. Station B is a private disclosure of low mood and intermittent self-harm requiring a risk assessment and a defensible confidentiality decision.
Station objectives
- Negotiate time alone and deliver a clear conditional-confidentiality script. [2] [3]
- Assess Gillick or Fraser capacity in a decision-specific way. [9]
- Perform a structured suicide-risk and self-harm assessment. [6]
- Make a defensible confidentiality decision and, where an override is needed, share the minimum necessary and tell the young person. [1] [6]
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References8Show ledgerHide ledger
- [1]Chung RJ, Lee JB, Alderman EM, et al Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics, 2024.PMID 38646690
- [2]Ford CA, Millstein SG Delivery of confidentiality assurances to adolescents by primary care physicians. Archives of pediatrics & adolescent medicine, 1997.PMID 9158445
- [3]Miller VA, Friedrich E, García-España JF, et al. Adolescents Spending Time Alone With Pediatricians During Routine Visits: Perspectives of Parents in a Primary Care Clinic. The Journal of adolescent health, 2018.PMID 29887486
- [4]Pasternak RH, Alderman EM, English A 21st Century Cures Act ONC Rule: Implications for Adolescent Care and Confidentiality Protections. Pediatrics, 2023.PMID 37010402
- [5]McKay EA, Brar P, Mehus CJ, et al. Parents' Perspectives on Confidentiality in Clinical Preventive Services for Adolescents. The Journal of adolescent health, 2025.PMID 40580168
- [6]Berlan ED, Bravender T Confidentiality, consent, and caring for the adolescent patient. Current opinion in pediatrics, 2009.PMID 19474734
- [8]American College of Obstetricians and Gynecologists Confidentiality in Adolescent Health Care: ACOG Committee Opinion, Number 803. Obstetrics and gynecology, 2020.PMID 32217979
- [9]Larcher V, Hutchinson A How should paediatricians assess Gillick competence? Archives of disease in childhood, 2010.PMID 19948515